EFTA01368295.pdf

IV. TAX ELECTIOWDECLARATION OF TAX STATUS This Account Agreement is designed for use by both U.S. Persons and Non-U.S. Persons. Please check the box next to the applicable Item below. Client certifies that CIlath will notify DBSI in witting immediately ff the representation certified to below ceases to be true and correct. 1.O V.S. Citizen or U.S. Resident Alien Form W9 ...-Request for Taxpayer Identification Number and Certification Substitute c Y)14/2 tVir VI" \ 1 WxCl Vir" ft \ Name (as shown on your interne tax return) nose mune/disregarded entity name, d different from Check appropriate box for federal tax classification (required): ❑ Individual/Kee proprietor ❑ C Corporation El S Consolation 0 Partnership OTrustrestate 0 Exempt payee 0 Limited liability company. Enter the tax classification (C-C corporation, SsiS Corporation, Pepartnerithip) ► Other ► Athirst: (number, street. and apt. or suho no.) City. State, end ZIP code Porl Taxpayer Identification Number {TIN) Social Security Number Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name' line to avoid backup withholding. For individuals. this is your social security number ISSN). For other entities, It Is your employer Identification number (EIN). Ian Employer Identification Number Certification Under penalties of Pedant. I certify that 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a outlaw to be issued to me). and 2.1 am not subject to backup withholding because: (a) I am exempt from backup withholding. or Oil I have not been notified by the Internal Revenue SONVIC.IIRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3.1 am a U.S. citizen or other U.S. person (defined Si the instructions). Certification instructions. You must-ctoili Oin em 2 above if you have been i At' by the IRS that you are currently subject to backup withholding because you have failed to report a Interest a dividends on your Sign Signature of Here U.S. person 2.0 Non-U.S. Person I am not a U.S. person Pricks:ring a U.S. resident I am submitting the applicable Form W-8 with this form to certify my foreign status and, If applicable, claim tax treaty benefits. For example: Client is not a U.S. person (including a U.S. resident aRen). Client agrees to provide DBSI with this application the applicable Internal Revenue Service (IRS) Form W4 to certify the client's foreign status. W-8 forms and instructions are available on the IRS wetisite at wwwirs.gov. 13-AWM-0196 6 012146.032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0059991 CONFIDENTIAL SDNY_GM_00206175 EFTA01368295